Selective Referral to High-Volume Hospitals

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Abstract
In the last 3 decades, many studies have shown that, for certain procedures and diagnoses, patients have lower mortality rates at high-volume hospitals (HVHs) than at low-volume hospitals (LVHs). Although early studies lacked sufficient case-mix adjustment, more recently, the creation of specialized databases has allowed more sophisticated—though likely still imperfect—case-mix adjustment.1 Studies using such data also show that HVHs have lower mortality rates for some conditions.1 With rare exceptions,2 health plans and purchasers have not attempted to selectively refer patients to hospitals with low case-mix–adjusted mortality or high volume. The absence of initiatives based on actual, case-mix–adjusted hospital outcomes may reflect the limitations of hospital discharge databases in most states or evidence that random events can have as much influence on the observed mortality at an individual hospital as quality of care for some conditions.3,4